Fatal

by Michael Palmer

  “Get her, Verne!” the larger man shouted, speaking without the mountain twang Nikki had become used to over the day. “For chrissakes, just shoot the bitch!”

  “Shit, Larry, she broke my tooth. She broke my fucking tooth in half!”

  Nikki was several paces inside the trees when she dared checking over her shoulder. Larry, Mr. Business Suit, was wobbly, but upright. He had shed his jacket, revealing a torso the size of a Volkswagen. Sun sparkled off his expansive white dress shirt, highlighting a shoulder holster on the left and dark sweat stains beneath his ham-hock arms. Verne, also on his feet, seemed less dazed. He had pulled a snub-nosed pistol out of the front of his waistband and was starting across the road after her, still rubbing his jaw. He fired once, but Nikki was charging ahead into the brush and had no idea if the shot was even close.

  These men know who I am and are trying to kill me! her mind screamed. Move! Just move!

  Terrified and bewildered, she raced ahead, trying to get a sense of her situation and to formulate some sort of plan. On her side of the ledger, she was in far better shape than Larry and probably as fit as Verne. Also, she was running for her life.

  Her disadvantages were obvious—two men with guns, knowing the area, angry as hornets, and determined to kill her. Not good. Still, she could feel herself maintaining some composure and continuing to fight the urge to panic.

  “Cut in over there!” she heard Verne call out. “If I don’t get her first, she’s going to run out of real estate in a hurry. Just don’t let her backtrack.”

  Nikki held her hands in front of her eyes to keep from being blinded by slashing branches. The town was several miles to her left. To her right, from what she could remember, was nothing until the main highway, maybe ten miles away. Verne sounded concerned about her doubling back between them, so that might be what she should do. She quickly rejected the notion. The chances of getting caught by one of them while heading back toward the road seemed too great, especially when there was no guarantee even if she made it that a car would come. It had to be straight ahead, searching for a place to hide until dark. Then she could make her way back into Belinda.

  A plan, however thin, decided upon, she flattened herself behind the thick trunk of a tree and listened. Verne wasn’t that far behind. She could hear him speaking. It took a while before she realized that he wasn’t speaking, he was singing—singing to her in a twisted, haunting child’s voice.

  “Come out, come out, wherever you are. All-ee, all-ee in free. Come on, little lady, there’s no place to go.”

  Her focus on Verne was interrupted by a gunshot from off to her left. The bullet slammed into the tree where she was hiding.

  “What in the hell’re you doing?” Verne called out.

  “She’s right there, jerk,” Larry responded. “Right behind that tree. Give it up, Doc. There’s no place you can go.”

  There was a second shot, then a third, but Nikki was already sprinting ahead, weaving through trees and leaping over brush. The huge killer had moved much quicker than she would have imagined him capable of. Underestimating him was a mistake she wouldn’t make again. The trees and dense undergrowth were both her ally and her enemy, concealing her to some degree, but at the same time tearing at her face and arms, threatening to trip her, or blind her, and always keeping her from getting up much of a head of steam.

  Why are you doing this to me? Why?

  Nikki wanted to stop and scream out the question. But these were men with orders, not answers. Instead, she plunged ahead, splashing into a shallow stream and trying, for a few dozen yards, to sprint down the center of it. There had to be somewhere to hide, or else a path where she could accelerate and put some distance between her and the men. She slipped on wet stones once, then again. Finally, she abandoned her efforts and scrambled up the muddy bank.

  “She’s in the brook,” Verne called out. “No, there she is, on the other side. This way! This way!”

  Two more gunshots cracked off. One of them snapped a branch right next to Nikki’s face. Unless she could get some space to use her speed, she was going to be shot. She cut to her right, running low to make herself less of a target and to prevent the bushes from getting a straight-on whip at her eyes. It was late summer and the forest floor offered no collections of dead leaves large enough to hide her. She was gasping for air now, struggling to maintain her pace. But she knew she was slowing down. A voice inside began telling her to huddle on the ground behind a tree and simply pray they overlooked her. What other chance did she have?

  She knelt on one knee and remained motionless as she tried to regain her wind. For ten seconds, fifteen, all was quiet. Could she possibly have outdistanced them that much in such a short time? The question was answered moments later by the breaking of a stick and some bushes rustling. At least one of them was near—very near. She was gripped by fear now, out of ideas. Again her internal voice warned her to stay put and take her chances. Her instincts urged otherwise. She sprang up and again began running, crashing through the dense brush.

  “This way! Over here!” Verne cried out.

  Nikki burst through some bushes and stopped short. She was standing in bright sunlight at the upper border of a rock ledge. Stretching out before her was a lake, nestled in a bowl of verdant forest. The ledge sloped slightly downward for about ten yards to a sheer drop-off fifteen feet above the water’s surface. In the distance she could barely make out a couple of boats. This is what Verne had meant when he said she would soon run out of room. Her composure was completely gone now. “Cube” no longer existed. She was trapped and going to die, and all she could think of to do was scream.

  She sensed both killers pinching in on her. Running from them was no longer an option. The only move she could fix on was the lake—to dive in fully clothed and hope she wasn’t a fish in a rain barrel. At the instant she turned to charge down the granite slope, there was a gunshot, then another. The second bullet grazed the side of her skull, just above her ear. Stunned, she spun and fell heavily. Her head struck the rock with dazing force. Helpless and barely conscious, she rolled down the incline and off the ledge.

  She hit the surface of the lake face first, aware only of the cold water enveloping her and the fact that she couldn’t seem to move in any purposeful way. The fall had driven most of the air from her lungs, and as soon as she entered the water, she began drifting downward. Within ten seconds, she had settled on the stony bottom. For a few moments she was aware, and consumed with the horror of her situation. Then, as blackness and peace closed in around her, she took a breath.

  CHAPTER 14

  IT WAS AFTER TEN IN THE MORNING WHEN MATT finally felt comfortable leaving Lewis with his brothers. Frank seemed naturally to assume the role of chief caregiver, and compared to Lyle and Kyle, he was Matt’s odds-on choice for the job. Matt gave him a set of wound-care instructions and general observations to make, begged him to bring Lewis into the hospital if there was any change for the worse, and promised to return as soon as his workload permitted. Then he revved up the Vulcan and headed back toward his place to shower, change, and call Mae.

  “Dr. Rutledge, I was just about to send the police out to your house,” she said.

  “Sorry. I went for a long ride last night and ended up sleeping under the stars.”

  “There were no stars last night, sir,” Mae replied in a syrupy drawl. “No need to waste the truth on me. I’m your biggest fan, and I’m going to believe whatever you say.”

  “That’s just as well, Mae. Believe me. Everything okay?”

  “No, everything is not okay. You are on backup for the ER today and they’ve been trying to reach you for an hour.”

  “Lord.”

  “Pardon?”

  “I said, I’ll call them right away.”

  “The nurse said something about a fifty-year-old man from Hawleyville with diarrhea and a fever and no doctor.”

  “He’s in luck. I was voted the fever/diarrhea prize at Harvard. Is the office okay?�
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  “The office is fine. . . . Are you?”

  “What are you, some kind of witch?”

  “There are those who might say so. Anything I can do?”

  “Not at the moment. Just keep the afternoon as light as possible.”

  “I’ll do my best.”

  Matt called the ER and gave several holding orders—diagnostic and therapeutic—on a farmer who sounded as if he might have contracted a bacterial infection in his intestine, possibly salmonella or shigella. Then he stripped in his bedroom, kicked his filthy clothes under a chair, and basted himself in a shower as hot as he could stand. The scratches and nicks on his face weren’t as bad as he’d anticipated, but it took several minutes of scrubbing before he realized that the blackness enveloping his eyes had nothing to do with Lewis’s camouflage potion, and wasn’t going to wash away.

  As he was toweling off, he glanced over at the book on the toilet tank: Manual of Medical and Surgical Field Emergencies. It would probably be a lifetime before he ever needed to perform one of the procedures again. Still . . . He briefly flipped through the pages and then moved the book to the more prestigious location on his bedside table.

  THE FARMER WITH fever and diarrhea was dehydrated and in moderate abdominal discomfort. Matt evaluated him, wrote a set of orders, and dictated his lengthy admission note. He was praying for an easy day, but that was simply not happening. Twenty minutes later, a ninety-year-old woman arrived by ambulance, sent in from one of the nursing homes with a dense stroke, unable to move her right side or speak. It was a medical and ethical nightmare, and of course her primary-care doc was on vacation. Matt wondered about the wisdom of treating her at all. He stood at her bedside, cradling her gnarled hand in his, looking into her glazed-over eyes, but receiving no definite message. His mother was much younger than this woman and wasn’t nearly at this point yet, but her Alzheimer’s was advancing steadily, and before too many more years, he would be facing constant questions of what was cruel treatment and what was not. But today was today for his mother, just as it was for this poor woman. Sighing, he picked up her chart and wrote orders for hydration, diagnostic studies, and a stat neurology consult. He would need more information about her, much more, before he put on his long white robes and began playing God.

  By the time he had completed his second lengthy admission dictation of the day, seen several scheduled appointments in the office, and made rounds on his three other hospitalized patients, the afternoon was fading. Back in the ER, he consulted a list he had compiled of equipment and medications to be “appropriated” from the hospital for Lewis. He had just put together a real chest tube and drainage system when an ambulance EMT, who had been drinking coffee in the lounge, hurried out to him. His name was Gary Lydon. He was earnest, baby-faced, and not much more than twenty.

  “Dr. Rutledge,” he said breathlessly, “dispatch just radioed. The police just got a call from a motorist on Wells Road. Apparently some kids just dove down and pulled a woman up from the bottom of Crystal Lake. They were fishing beneath Niles Ledge when she tumbled off it from right above them, and just sank.”

  “She’s alive?”

  “So they say.”

  Kirsten Langham, the second EMT, joined them. She had a bit more experience than Gary, but was still fairly green. It wasn’t like Rescue to put together such a team. Matt accompanied the pair out to their ambulance.

  “How long was she under?” he asked.

  “Dispatch didn’t say. There’s a problem, though.”

  “What?”

  “Rick Wise is the paramedic on this shift and he’s off on Harlan Road picking up a motorcyclist. If this woman needs to be intubated, neither me nor Kirsten is certified to do it.”

  Crystal Lake near Wells Road. Matt estimated that by the time the two EMTs got the woman out of the woods, into the ambulance, and back to the hospital, a half an hour would have passed, maybe even more. If she needed a breathing tube—and unless she was wide-awake and talking sensibly, she did—it should be done as soon as they reached her.

  “Hang on for just a minute,” he said. “I’m going with you.”

  “Bless you, Doc,” Gary said. “I’ll save you a seat up front.”

  “No, I want to be in back to check the equipment.”

  “Kirsten’ll help you. I’ll drive.”

  Matt raced into the ER, told the nurses where he’d be, and then hustled into the rear cabin of the ambulance. The return trip to the Slocumbs’ farm was just going to have to wait. Hopefully, Lewis was still stable. If not, Frank Slocumb had better have the courage and good sense to bring him in.

  Siren blaring, the ride to the spot on Wells Road took ten minutes. An empty Belinda PD black-and-white was parked on the soft shoulder, flashers on. Gary Lydon drove past the cruiser before pulling over beside a narrow trail that Matt knew led into Niles Ledge. He had prepared the large plastic crash case with all the equipment he might need to intubate. Hauling the case, he raced through the woods, sensing a powerful, unpleasant feeling of déjà vu. What Lewis and he had been through already seemed like a year ago. After a quarter of a mile, the winding track split—one path to the top of the ledge and one down to the water.

  “Take the right fork,” he hollered, on the off chance that the EMTs hadn’t grown up in the area.

  “We hear you,” Gary called back.

  The scene under the massive ledge was impressive. Several fishing skiffs had tied up along the shore, and their occupants had joined two uniformed policemen and two teenage boys. Crystal Lake was long and fairly large. The ledge, situated in a broad cove near the south end, was difficult to reach, but offered diving into fifteen feet of water, and around it, some decent fishing as well. The two boys, still wearing their waterlogged jeans but no shirts or shoes, stood off to the side. A policeman knelt beside a supine woman, alternately giving her a mouth-to-mouth breath and pausing to watch her take an occasional shallow breath on her own.

  “These boys here are heroes, Doc,” the standing policeman said proudly. “They saved her.”

  But what’s left? Matt wondered as he knelt beside the other cop.

  “Officer Gibbons, sir,” the young policeman said. “I think we’ve met before.”

  “What’s the story?” Matt asked, already into his examination.

  The woman, thin, white, in her thirties, was unconscious and breathing ineffectually. Her dark hair was matted to her forehead. Her lips were purple. The officer was right to keep breathing for her, and Matt told him to continue. Her pupils were midposition, but did not react to a flash from his penlight—either the result of a technically limited exam, or a very grim sign. She wore jeans, sneakers, and a black T-shirt with a wavy musical scale on the front, and had a raw bruise and abrasion just above her left eye. There was also a long laceration, more of a gouge, along the hairline, just above her right temple.

  The EMTs arrived and Matt instructed them to begin breathing her with a bag as soon as they could.

  “These boys were fishin’ here,” the standing officer said, “when suddenly this lady came plungin’ off the ledge from up above them. One of them, Percy Newley’s boy Harris, swears he heard something like a gunshot just before she flew past him and into the water.”

  “Did they get her up on the first try?” Matt asked, listening to her chest with his stethoscope as he was speaking.

  “Excuse me?”

  “Percy’s boy and his friend, did they haul her up on the first dive?”

  The officer’s sheepish expression said that he had just grasped the significance of the question he clearly hadn’t asked.

  “Harris, how many tries did it take for you to pull this woman off the bottom?”

  “Two. Michael tried first, then we did it together. We hauled her up by the hair.”

  “Thank you,” Matt said, already preparing for an intubation.

  He estimated the submersion time at two minutes and hoped he wasn’t giving the boys too much credit. Meanwhile, Gary was se
tting the triangular cup of the breathing bag in place over the woman’s mouth and nose while Kirsten was inserting an IV. After the breathing tube was in place, the cup would be set aside and the bag connected directly to the tube.

  “Normal saline?” Kirsten asked.

  “Exactly,” Matt said. “You’re all doing great. Thanks to these heroes and the good mouth-to-mouth technique they did, this lady’s going to make it. But she still needs our help. I’m going to put a breathing tube in so we can get some concentrated oxygen into her lungs. Let’s put her on the stretcher, Gary, and lift her up. I’d rather work with a little elevation than stretched out on my belly with her flat on the ground.”

  In the hospital, the anesthesiologists were the royalty of intubation, having honed their skills hundreds of times in the operating room. During one of his residency electives, Matt had chosen anesthesia and “tubed” dozens of cases under their guidance. Over the years that followed, he had multiple reasons to be grateful for every one of those opportunities. The main rule he had learned was that if the caregiver performing the procedure wasn’t absolutely comfortable, physically and mentally, the chances of a failed intubation were greatly increased. The most common disasters were intubating the esophagus instead of the trachea, thereby filling the stomach with air; tearing the tissues of the throat and causing bleeding, which made subsequent attempts that much more difficult; damaging the vocal cords by forcing the tube down without adequate visualization; and finally, inserting the tube too deeply and occluding one of the two main bronchial tubes.